COMPLAINT PATTERNS IN US NURSING HOMES: 2013–2017

Abstract Nursing home (NH) quality of care is often short of meeting residents' and family expectations to maintain optimum quality of life. Using complaints as a facility-level outcome (i.e., complaints per NH), this study updates earlier published findings by replicating prior analyses with more recent data, and by analyzing the number of complaints, complaint allegations, and deficiency citations separately. This will allow us to determine whether any major change has taken place in the consumer complaint pattern in recent years. The result reveals, in the entire study period (2013-2017), overall, 458,101 complaints (5.9/NH/year) were identified that contain 949,466 allegations (12.2/NH/year), which resulted in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, the results show a steady increase compared to previous years. Furthermore, there are marked differences among the ten CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. The current study found a lower number of NHs with zero complaints and a higher number of NHs with five/more complaints in later years suggesting a steady increase in the number of complaints over the years. However, the average rate of substantiation of complaint allegations is showing a decreasing trend in recent years. This may be because people are now complaining more due to higher care expectations. Alternatively, it may be simply be because of the easier complaint lodging process developed in recent years. Other policy and practice implications will be discussed.


University of South Florida, Tampa, Florida, United States
Nursing home (NH) quality of care is often short of meeting residents' and family expectations to maintain optimum quality of life. Using complaints as a facility-level outcome (i.e., complaints per NH), this study updates earlier published findings by replicating prior analyses with more recent data, and by analyzing the number of complaints, complaint allegations, and deficiency citations separately. This will allow us to determine whether any major change has taken place in the consumer complaint pattern in recent years. The result reveals, in the entire study period (2013)(2014)(2015)(2016)(2017), overall, 458,101 complaints (5.9/NH/year) were identified that contain 949,466 allegations (12.2/NH/year), which resulted in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, the results show a steady increase compared to previous years. Furthermore, there are marked differences among the ten CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. The current study found a lower number of NHs with zero complaints and a higher number of NHs with five/more complaints in later years suggesting a steady increase in the number of complaints over the years. However, the average rate of substantiation of complaint allegations is showing a decreasing trend in recent years. This may be because people are now complaining more due to higher care expectations. Alternatively, it may be simply be because of the easier complaint lodging process developed in recent years. Other policy and practice implications will be discussed.

THE IMPACT OF DIFFERENT PATTERNS OF HOME-AND COMMUNITY-BASED SERVICES AND FACTORS ON MULTIDIMENSIONAL UNMET NEEDS
Ya-Mei Chen, Zi-Ting Zhong, and Shih-Cyuan Wu, National Taiwan University, Taipei City, Taipei, Taiwan (Republic of China) Background: Long-Term Care (LTC) in Taiwan has been implemented over the last 15 years, focusing on providing home-and community-based services (HCBS). Previous studies have shown that care recipients' level of unmet needs is associated with adverse health outcomes. This study aimed to identify HCBS use patterns among LTC care recipients and examine the impact of different patterns of HCBS on unmet needs.
Methods: Surveys of service users were conducted in eight counties. Latent class analysis was used to identify the underlying subgroups of LTC recipients. Multiple regression analysis was used to assess the impact of HCBS patterns and care recipients' predisposing, enabling, and need factors on the level of unmet needs.
Results: A total of 952 participants from northern, middle, and southern Taiwan completed the surveys. Three subgroups based on HCBS use were identified, including homebased personal care (HB-PC), home-based personal care and medical care (HB-PC/MC), and community care (CC). Care recipients in the HB-PC group (β = −1.922, p = 0.028) and the CC group (β = −2.177, p = 0.019) had lower unmet needs than those in the HB-PC/MC group. A lower disability level, living in a highly urbanized city, and lower levels of quality of life were associated with higher unmet needs (p < 0.05).
Conclusions: Our results demonstrating that care recipients with lower disability levels had higher unmet needs may indicate insufficient funding support from Taiwan's LTC plans. However, multiple service users had high unmet needs, which warrants further investigation. Federal and state long-term care policies are focused on helping people age in their community rather than in nursing homes or other institutional settings. Through home-and community-based (HCBS) waiver programs, states have the flexibility to target specific populations, providing supportive services meant to promote residence in the community. Although consumer needs and goals are a key component of HCBS delivery and effectiveness, little is known about how actual service use differs from the services individuals desire to meet their needs. Using the National Core Indicators-Aging